HIV care transformed by Dr. Peter’s Legacy

’Twenty years after Peter Jepson-Young’s death, the centre that bears his name is synonymous with inclusive, cutting-edge programs.

By Daniel Gawthrop

Published in the Georgia Straight on November 15, 2012

When Peter Jepson-Young died of AIDS on November 15, 1992, the man better known to British Columbians as “Dr. Peter” had one last wish: that a foundation created in his name be used to help people living with HIV/AIDS who were less fortunate than him. “There is no substitute,” the host of CBC’s AIDS Diary said in a final statement, “for the ongoing involvement and support of caring people. Persons living with HIV and AIDS have needs greater than just survival.”

Twenty years later, the reality has eclipsed the dream. Today, the closing words of Dr. Peter’s “Affirmation”, a meditation that Jepson-Young wrote shortly after his AIDS diagnosis (“The energy that is me will not be lost”), appear in descending order on the steps leading to the Dr. Peter Centre, a 30,000-square-foot complex in downtown Vancouver dedicated to “comfort care” for people living with HIV/AIDS. Since opening in 2003 as a full-service, stand-alone facility (after six years in St. Paul’s Hospital’s Comox wing), the centre has become synonymous with cutting-edge health care and healing with dignity.

True to Dr. Peter’s vision, the centre caters primarily to the Lower Mainland’s most unfortunate HIV-positive citizens: the drug-addicted, the homeless, the impoverished, and the mentally ill. Its 24 residential suites provide shelter for up to 50 people a year, while its supportive-housing program funds more than a dozen off-site beds. Its day health program, which supported 150 people when it left St. Paul’s, now serves more than 400. The centre’s much-vaunted “integrated model” of care features three nutritious meals a day, medication maintenance, art and music therapy, field trips, counselling, specialized nursing, and a supervised safe-injection program that is the envy of harm-reduction advocates everywhere.

Donors are generous, last year shelling out $982,817 at a time when AIDS walks were tanking everywhere. Researchers from across Canada flock to the centre to analyze its health-care outcomes. And delegations from China, Poland, and even Iran have come knocking, in search of the secret that might one day help spawn a Dr. Peter Centre in their own socially conservative states. Meanwhile, architects admire the building’s natural blend of modern design and heritage values with a supportive environment and trendy Mole Hill address. And oh, yeah: Tom Hanks—the Hollywood actor that Jepson-Young once considered “hot”—is the Dr. Peter AIDS Foundation’s celebrity ambassador.

How cool is that, the Georgia Straight asks Dr. Peter’s mother, who still serves breakfast every Wednesday in the centre’s café.

“There are times when I just feel like pinching myself; I mean, is this real?” says Shirley Young, sitting down for coffee recently. “When Peter was first diagnosed in 1986—and we didn’t think he would even get out of hospital, because he spent a month on life support and then suffered cardiac arrest—I used to walk across the street from here in Nelson Park, and usually I’d be crying,” she recalls. Years later, when Peter was long gone and the centre was under construction, she shared a vision with her husband: “I said to Bob, ‘Can you just imagine, in 1986, when I’d be walking in Nelson Park in such despair, if the fairy godmother had appeared and tapped me on the shoulder, saying: “Don’t despair. I promise you that one day there will be a centre that will look after patients just like your son. It will be right across the street, and it will be called the Dr. Peter Centre.” Wouldn’t that have been something?’”

Young, now a spry 79, has come a long way from the conservative North Shore suburbanite who couldn’t accept that her son was gay, never mind that he had AIDS and would go on television to talk about it. Today, as a brief visit to the centre reveals, Dr. Peter’s mother has been transformed by her son’s legacy. Joined by her sister and niece as she serves breakfast to about a hundred HIV-positive souls, Young is completely at ease and loving every minute of it. She knows many of the people she’s serving by name and laps up the love they give her as the centre’s symbolic matriarch. Once a week, at least, she becomes their mother, and everyone—no matter how filthy, dishevelled, or strung-out—gets a hug.

“I know hundreds of people here that I would never have known because our paths would never have crossed, and I would be very sad not to have had that experience, because they’ve taught me so much,” she says. “I am convinced that Peter had a mission in life to help others, so that helps me cope with my grief of losing him. We were always sad that he never got to start his own medical practice. But now, the way things have turned out, this is his practice. These are his patients.”

And the patients—or participants, as the centre prefers to call them—seem pretty happy with the practice.

Raised in an abusive family, Lebreton ended up on the streets as a teenager and quickly turned to drugs and crime. He learned he was HIV-positive from a routine prison test in 1992. But he did nothing about it until 2002, when he found himself in 10-C, the AIDS ward at St. Paul’s, suffering from Pneumocystis pneumonia and losing 90 pounds in six weeks. He was prepared to die. But after being referred to the Dr. Peter Centre—and moving to its new building a year later—he turned his life around. Today, his hospital stays have long since ended and his criminal days are over. He still shoots up. But instead of sharing dirty needles in rodent-infested alleyways, he takes clean ones from a watchful nurse in the centre’s safe-injection room. “Since this place opened, I haven’t used a needle more than once,” he says.

Dr. Julio Montaner, director of the B.C. Centre for Excellence in HIV/AIDS, agrees that the centre’s integrated approach saves taxpayer dollars as well as lives. “Once you’re able to provide a secure, safe, and supportable environment to people that are otherwise challenged, then you’re mitigating against a whole lot of other things that can potentially go wrong,” he says. No longer desperate for their next meal or place to sleep, Montaner suggests, those who access the centre’s services become less of a burden for the health-care and criminal-justice systems.

Another participant, former arts administrator Ken Mazer, says the centre’s nonjudgmental philosophy has forced many people—himself included—to rethink their own prejudices. Mazer, 51, was struggling to pay rent when he signed up for the day program last spring. For a once high-functioning, well-connected gay man who would never have associated with the downtrodden, that first exposure to fellow Dr. Peter clients took some getting used to.

“There’s definitely a mixed demographic here,” he says with a laugh, recalling his first visit to the café. “When I stood there with my tray, looking through the dining room, I felt like it’s day one at high school. And then, as I looked around and saw all those gorgeous banners and the gay men sitting over there, it felt more like Oz. And then, as I was actually sitting down to eat, a guy came in—probably from upstairs—dragging a catheter bag on the floor. And he’s, like, freaking out and swearing, and I’m like, ‘Oh, my God, now it’s One Flew Over the Cuckoo’s Nest.’ ”

Mazer has written a paper, “AIDS Makes Strange Bedfellows”, for his humanities course at UBC. The paper describes the unique culture of learning that the centre has created by combining such diverse HIV-positive populations.

“Most talk of Dr. Peter then, as now, was his basically unprejudiced compassion. He was blind to the social distinctions that we often make in terms of defining others,” Mazer tells the Straight. “There are guys here who are avoided by others because they are so literally fucked-up. Or they stink. But I talk to everyone. I guess there’s a sort of solidarity that we share based on our common status as HIV-positive. And we have to get along, because if you’re trouble, you’re going to be banned, and nobody wants that.”

Lynne Belle-Isle, a national-programs consultant for the Canadian AIDS Society, says the centre’s biggest contribution has been its leadership in serving populations that have difficulty accessing traditional health services. “The Dr. Peter Centre was at the forefront of creating services for people who are not only stigmatized because they have HIV/AIDS but also marginalized because of social barriers,” she says. “So the nurses have to be really commended for their work.”

Belle-Isle—coauthor of a Canadian Harm Reduction Network report that canvassed drug users’ experiences across the country—says that health-care agencies continue to shy away from supervised injection, mostly due to political resistance. “Whereas the [centre’s] nurses, you know, they just said, ‘Well, we have to do this. It’s unethical not to—end of story.’ ”

Asked how the Dr. Peter AIDS Foundation has managed to prosper (while other name-branded organizations wither), executive director Maxine Davis points to the brand itself. Dr. Peter’s iconic status is such that he is listed in the B.C. Almanac Book of Greatest British Columbians, in the Crusaders and Reformers category, as one of our province’s hundred greatest people of all time.

“Everyone, including myself, is inspired by that iconic person,” Davis says. “While it can’t keep you going forever, it’s a grounding. I also think that as an organization, we’ve been intentionally strategic. We’ve stuck with the mission, and we were smart enough that the intentional strategic thinking was: ‘We need to deliver a service that the health-care system needs.’ ”

Like Davis, those who work for the city’s other HIV service organizations understand how those needs evolve. John Bishop, chair of Positive Living B.C., says that one of the biggest challenges remains serving HIV-positive people where they live. “We’ve had conversations about the need for facilities that the Dr. Peter Centre provides, in terms of clinical care, away from this region,” says Bishop. “Needing them in Abbotsford; needing them in Surrey; needing them in Langley. Those are the areas where the lack of services is absolutely pathetic.”

In terms of housing, Bishop and Davis agree that the big crunch will come with the increasing population of aging, HIV-positive gay men. “I could envision the Dr. Peter AIDS Foundation having what I would call a virtual ‘campus of care’ in the West End,” Davis says, “where people would not have to leave the community in order to get the care they need.” (One of Davis’s recent plans, to acquire suites at the controversial proposed Westbank building at 1401 Comox Street, was reinforced by community outrage that a West End resident dying at St. Paul’s was told he’d have to go to a Surrey hospice.)

The Downtown Eastside has its own housing pressures. A few years ago, the Dr. Peter Centre, the Vancouver Native Health Society, and the Vancouver Native Housing Society began discussing the need for more beds and more Dr. Peter–like services in the DTES. At one point, they even identified a specific property that could have been used for social housing and operated as a 24-hour licensed-care residence by the Dr. Peter Centre.

“There’s a reluctance on the part of many people down here to cross Cambie,” says Vancouver Native Health Society executive director Lou Demerais, stressing the need for neighbourhood-specific, HIV/AIDS comfort care. Although the tripartite plan was dashed by Vancouver Coastal Health, he adds: “The idea is still very much there. And when we bump into each other, we still talk about the possibilities.”

When it comes to Dr. Peter, after all, anything seems possible.

Daniel Gawthrop is the author of Affirmation: The AIDS Odyssey of Dr. Peter (New Star).